Chronic kidney disease in the pediatric population produces numerous detrimental effects including growth retardation. Kidney transplantation in these patients is indispensable. The results of 80 pediatric kidney transplantations performed on 78 patients at our center from November 1975 to June 2004 were retrospectively analyzed. There were 42 male and 36 female recipients (aged 8-18 years). Sixty-two (75%) patients were on hemodialysis and 14 (17.5%) were on peritoneal dialysis prior to transplantation. Preemptive transplantation was performed in 2 patients. Sixty-three kidneys were harvested from living donors (37 mother, 20 father, 4 siblings, 2 second-degree related), and 15 were from cadavers. The mean cold ischemia time for cadaveric donors was 38.6 hours (range, 23-56 hours). Kidneys were placed in the recipient’s iliac fossa through an extraperitoneal approach. All recipients received low-dose triple-drug immunosuppression drug regimens. One graft was lost owing to hyperacute rejection. There were 25 rejection episodes in 22 patients (28.7%). In each case, diagnosis of acute rejection was suspected owing to an elevation of plasma creatinine levels, proteinuria, and tenderness over the graft. Doppler ultrasonography and renal scintigraphy were used to exclude other causes of renal function deterioration. Needle biopsy of the graft was performed for the final diagnosis. Acute allograft rejection episodes were treated with IV methylprednisolone pulse therapy, and in 6 steroid-resistant episodes, OKT3 and plasmapheresis on alternate days for up to 10 days were used. Follow-up ranged from 1-190 months (mean, 64.6 ± 49.2 months). Postoperative complications included hypertension in 1, herpes zoster in 2, distal ureteral stricture in 2, lymphocele in 4, perirenal hematoma in 2, and renovascular stenosis in 2 patients. Two patients developed Kaposi’s sarcoma at 3 and 17 months after transplantation. There were a total of 6 deaths (4 with functioning grafts). Two patients had retransplantations (at 2 and 4 years after the first one). The 1-, 3-, and 5-year graft survival rates for living-related transplantations were 92%, 81%, and 70%, respectively, and the patient survival rates were 98%, 93%, and 92%. The 1-, 3-, and 5-year graft survival rates for cadaver transplantations were 90%, 78%, and 68%, respectively, and the patient survival rates were 98%, 91%, and 90%. Successful pediatric kidney transplantations has been performed in both hemodialysis and peritoneal dialysis patients, with reasonable morbidity and mortality rates at our center. This is the best therapeutic option for children with end-stage renal disease, because it yields physiological and psychological improvements and provides adequate growth more effectively than does chronic dialysis.